Prevalence of depressive disorders and treatment in China: a cross-sectional epidemiological study
Abstract
Background In China, depressive disorders have been estimated to be the second leading cause of years lived with disability. However, nationally representative epidemiological data for depressive disorders, in particular use of mental health services by adults with these disorders, are unavailable in China. The present study, part of the China Mental Health Survey, 2012-15, aims to describe the socioeconomic characteristics and the use of mental health services in people with depressive disorders in China.Methods The China Mental Health Survey was a cross-sectional epidemiological survey of mental disorders in a multistage clustered-area probability sample of adults of Chinese nationality (≥18 years) from 157 nationwide representative population-based disease surveillance points in 31 provinces across China. Trained investigators interviewed the participants with the Composite International Diagnostic Interview 3.0 to ascertain the presence of lifetime and 12-month depressive disorders according to DSM-IV criteria, including major depressive disorder, dysthymic disorder, and depressive disorder not otherwise specified. Participants with 12-month depressive disorders were asked whether they received any treatment for their emotional problems during the past 12 months and, if so, the specific types of treatment providers. The Sheehan Disability Scale (SDS) was used to assess impairments associated with 12-month depressive symptoms. Data-quality control procedures included logic check by computers, sequential recording check, and phone-call check by the quality controllers, and reinterview check by the psychiatrists. Data were weighted according to the age-sex-residence distribution data from China's 2010 census population survey to adjust for differential probabilities of selection and differential response, as well as to post-stratify the sample to match the population distribution.Findings 28 140 respondents (12 537 [44·6%] men and 15 603 [55·4%] women) completed the survey between July 22, 2013, and March 5, 2015. Ethnicity data (Han or non-Han) were collected for only a subsample. Prevalence of any depressive disorders was higher in women than men (lifetime prevalence odds ratio [OR] 1·44 [95% CI 1·20-1·72] and 12-month prevalence OR 1·41 [1·12-1·78]), in unemployed people than employed people (lifetime OR 2·38 [95% CI 1·68-3·38] and 12-month OR 2·80 [95% CI 1·88-4·18]), and in people who were separated, widowed, or divorced compared with those who were married or cohabiting (lifetime OR 1·87 [95% CI 1·39-2·51] and 12-month OR 1·85 [95% CI 1·40-2·46]). Overall, 574 (weighted % 75·9%) of 744 people with 12-month depressive disorders had role impairment of any SDS domain: 439 (83·6%) of 534 respondents with major depressive disorder, 207 (79·8%) of 254 respondents with dysthymic disorder, and 122 (59·9%) of 189 respondents with depressive disorder not otherwise specified. Only an estimated 84 (weighted % 9·5%) of 1007 participants with 12-month depressive disorders were treated in any treatment sector: 38 (3·6%) in speciality mental health, 20 (1·5%) in general medical, two (0·3%) in human services, and 21 (2·7%) in complementary and alternative medicine. Only 12 (0·5%) of 1007 participants with depressive disorders were treated adequately.Interpretation Depressive disorders in China were more prevalent in women than men, unemployed people than employed, and those who were separated, widowed, or divorced than people who were married or cohabiting. Most people with depressive disorders reported social impairment. Treatment rates were very low, and few people received adequate treatment. National programmes are needed to remove barriers to availability, accessibility, and acceptability of care for depression in China.Funding National Health Commission and Ministry of Science and Technology of People's Republic of China.Translation For the Chinese translation of the abstract see Supplementary Materials section.
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Mental health services are few and still underutilized globally.
“However, mental health services are few and still underutilized globally [4-6].”
From Conversational Agent Interventions for Mental Health Problems: Systematic Review and Meta-analysis of Randomized Controlled Trials (2023) · cites this paper as [4]
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“In China, depressive disorder ranks second in the list of causes of disability [2].”
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“5% of the patients are fully treated (Huang et al., 2019; Lu et al., 2021).”
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“Lu et al. (2021) found that the treatment rates of sD might be very low, and a few individuals receive adequate treatment in China, underscoring the importance of national programs to eliminate barriers to availability, accessibility, and acceptability of care for sD in China.”
BackgroundSelf-citationAcupuncture for Major Depressive Disorder: A Data Mining-Based Literature Study
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“45 LR3 (213), SP6 (194), ST36 (141), KI3 (80), ST40 (52), LR2 (40), GB34 (26), KI6 (17), SP9 (16), GB43 (14), ST44 (13), KI1 (12), SP4 (12), SP10 (9), SP1 (9), BL62 (8), ST37 (7), SP3 (6), LR8 (6), GB40 (3), GB41 (2), SP5 (2), LR5 (2), LR6 (2), GB39 (2), ST34 (1), LR7 (1), ST32 (1), ST41 (1), KI4 (1), LR1 (1), GB37 (1…”
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“5% of patients received adequate treatment (3).”
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“Depression is a psychiatric illness that severely influences the mood, causing anhedonia, and anxiety in patients.(1,2) In addition, depression impairs quality of life and makes patients feel sadness, hopelessness, and helplessness.”
BackgroundKong, X., Wu, Y., Wang, X., Sun, Y., Chen, K., Li, Q., & Li, J. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e15889 · Cited by 29 · see citing works
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“20 Taylor series linearization was used to estimate standard errors and to determine 95% confidence intervals (95% CIs) for prevalence estimates.”
MethodSelf-citationExamining the mental health services among people with mental disorders: a literature review
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Working memory function in patients with major depression disorder: A narrative review
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The relationship between BMI and depression: a cross-sectional study
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“Only 9.5% with 12-month depressive disorders were treated at all, and only 0.5% were treated adequately (Lu et al ., 2021).”
BackgroundInfluentialPeripheral mitochondrial DNA as a neuroinflammatory biomarker for major depressive disorder
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“On the one hand, the prevalence of MDD has been reported to be higher among women [6].”
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“Considering depressive symptoms are easier and more convenient to diagnose than clinical depression, and a considerable number of older patients with MDD are underdiagnosed [9], the measures of depressive symptoms are used more frequently in mental health primary care and other epidemiological investigations to identi…”
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“Different studies have estimated consistently higher prevalence of depressive disorders among females than in males [24, 25].”
BackgroundMy Story of Depression: A Content Analysis of Autobiographic Videos on Douyin
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“Past research on stigma and stigma communication has shown that such internal attribution can lead to increased stigma (Huang et al., 2021).”
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Do the therapeutic effects of psilocybin involve actions in the gut?
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“The SDS was one of the most widely-used tools to measure depressive symptoms or activities, with prominently good psychometric merits in the general population 112,113 .”
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“It was estimated that the prevalence of depression among adults in China is 6.8% through the China Mental Health Survey [8].”
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“Despite these challenges, the treatment rates of depressive disorders in China have been reported to be very low, with only a small number of individuals receiving sufficient treatment in 2019 [11].”
BackgroundSelf-citationChina initiates depression screening in children and adolescents
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“In addition, more willingness to admit symptoms than before (22), may also contribute to the increase of schizophrenia incidence.”
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Self-citationAssociation of triglyceride-glucose index with major depressive disorder: A cross-sectional study
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“[6,7] MDD has been the second leading cause of disability-adjusted life years in China since 2010.[8] Current treatments for depression are symptom-suppressing.”
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“Major depressive disorder (MDD) is one of the most common psychiatric disorders and a leading cause of disability worldwide (Hasin et al., 2018; Iancu, Wong, Rhebergen, van Balkom, & Batelaan, 2020; Lu et al., 2021).”
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Machine learning algorithms to predict depression in older adults in China: a cross-sectional study
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“As the second-leading cause of years lived with disability in China, MDD imposes a substantial burden on patients, impairing both functioning and quality of life.(6,7) MDD also exacts a significant societal burden through both direct and indirect costs.”
BackgroundSelf-citation
- Authors
- Lu, J., Xu, X., Huang, Y., Li, T., Ma, C., Xu, G., Yin, H., Xu, X., Ma, Y., Wang, L., Huang, Z., Yan, Y., Wang, B., Xiao, S., Zhou, L., Li, L., Zhang, Y., Chen, H., Zhang, T., Yan, J., Ding, H., Yu, Y., Kou, C., Shen, Z., Jiang, L., Wang, Z., Sun, X., Xu, Y., He, Y., Guo, W., Jiang, L., Li, S., Pan, W., Wu, Y., Li, G., Jia, F., Shi, J., Shen, Z., & Zhang, N.
- Affiliations
- Urumqi 4th People's Hospital (CN)
- Peking University (CN)
- Sichuan University (CN)
- Tianjin Anding Hospital (CN)
- Chinese Center For Disease Control and Prevention (CN)
- Air Force Medical University (CN)
- Central South University (CN)
- Jilin University (CN)
- First Affiliated Hospital of Kunming Medical University (CN)
- Ningxia Medical University (CN)
- Shanghai Jiao Tong University (CN)
- Qinghai No.3 People's Hospital (CN)
- Soochow University (CN)
- Nanjing Medical University (CN)
- Hangzhou Seventh Peoples Hospital (CN)
- Nanjing Brain Hospital (CN)
- Corresponding author
- Huang, Yueqin
- ORCID
- Xu, Xiufeng
- Huang, Yueqin
- Li, Tao
- Ma, Chao
- Xu, Guangming
- Yin, Huifang
- Ma, Yanjuan
- Wang, Limin
- Wang, Bo
- Xiao, Shuiyuan
- Zhou, Liang
- Li, Lingjiang
- Zhang, Yan
- Chen, Hongguang
- Zhang, TingTing
- Yan, Jie
- Ding, Hua
- Yu, Yaqin
- Kou, Changgui
- Shen, Zonglin
- Wang, Zhizhong
- Sun, Xian
- Xu, Yifeng
- He, Yanling
- Guo, Wanjun
- Jiang, Lijun
- Li, Shengyan
- Pan, Wen
- Wu, Yue
- Li, Guohua
- Shi, Jianfei
- Shen, Zhongxia
- Zhang, Ning
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2021-11
- Volume
- 8
- Issue
- 11
- Pages
- 981-990
- ISSN
- 2215-0366 (ISSN-L)
- OpenAlex
- W3201200719
- Cited by
- 844
- References
- 39
- Citations by year
- 2026: 150 · 2025: 228 · 2024: 211 · 2023: 166 · 2022: 82 · 2021: 7
- FWCI
- 114.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- The Lancet Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Key Research and Development Program of China (2017YFC0907800, 2017YFC0907801)
- Center for Mental Health Services
- Ministry of Science and Technology of the People's Republic of China (2012BAI01B01, 2015BAI13B00)
- Ministry of Health of the People's Republic of China (201202022)
- School of Medicine, Shanghai Jiao Tong University
- Peking University
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
- Keywords
- depressive disorders, prevalence, mental health service utilization, treatment seeking, major depressive disorder, dysthymia, depressive symptoms, socioeconomic factors, unemployment, disability, China, gender differences, lifetime prevalence, 12-month prevalence, treatment providers, Han Chinese, ethnic minorities, mental health policy, mental health service planning, mental health professionals
- MeSH terms
- Global Burden of Disease, Adult, Aged, China, Cross-Sectional Studies, Major Depressive Disorder, Female, Humans, Male, Mental Health Services, Middle Aged, Population Surveillance, Surveys and Questionnaires, Risk Factors, Socioeconomic Factors, Prevalence, Age Distribution, Sex Distribution, Dysthymic Disorder, Diagnostic and Statistical Manual of Mental Disorders
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